			<form class="form-horizontal" name="add" id="add5" action="<?php echo $this->input->server('REQUEST_URI'); ?>" method="post">
				<input type="hidden" name="itemId" id="itemId" value="<?=$itemData['itemId']?>">
				<input type="hidden" name="actId" id="actId" value="<?=$actId?>">
				<input type="hidden" name="proId" id="proId" value="<?=$proId?>">
				<input type="hidden" name="type" id="type" value="5">
				<table class="table table-condensed" style="margin-top: 50px;">
					<tbody>
						<tr>
							<td class="active col-md-3 text-right">
								<label for="itemTitle">*请填写问题标题：</label>
							</td>
							<td>
								<input type="text" style="width: 400px" required class="form-control" name="itemTitle" id="itemTitle" value="<?=$itemData['itemTitle']?>" placeholder="问题标题">
							</td>
						</tr>
						<tr>
							<td class="active col-md-3 text-right">
								<label for="itemDesc">请填写反馈说明：</label>
							</td>
							<td>
								<textarea style="width: 400px; height: 150px;" class="form-control" name="itemDesc" id="remarks" rows="3" placeholder="反馈说明"><?=$itemData['itemDesc']?></textarea>
							</td>
						</tr>
						<tr>
							<td class="active col-md-3 text-right">
								<label for="orderNum">排序：</label>
							</td>
							<td>
								<input type="text" required data-validation-regex-regex="^[0-9]*$" data-validation-regex-message="请输入有效数字" class="form-control" style="width:200px;" name="orderNum" id="orderNum" value="<?=$itemData['orderNum']?>" placeholder="排序">数字越小越靠前
							</td>
						</tr>
						<tr>
							<td class="active col-md-3 text-right">
								<label for="isRequired">*是否必答题：</label>
							</td>
							<td>
								<label class="radio-inline">
								  <input type="radio" required name="isRequired" id="isRequired1" value="1" <?=isset($itemData['isRequired']) && $itemData['isRequired'] == 1 ? 'checked':''?>> 是
								</label>
								<label class="radio-inline">
								  <input type="radio" required name="isRequired" id="isRequired2" value="0" <?=isset($itemData['isRequired']) && $itemData['isRequired'] == 0 ? 'checked':''?>> 否
								</label>
							</td>
						</tr>
						<tr>
							<td class="active col-md-3 text-right">
								<label for="isRequired">*指定反馈时间段：</label>
							</td>
							<td>
								<label class="radio-inline">
							      <input type="radio" required name="limit[type]" id="limitType1" value="1" <?=isset($itemData['otherData']['type']) && $itemData['otherData']['type'] == 1 ? 'checked':''?>>
							      指定时间段
							      </label>
							      <label class="radio-inline">
							      <input type="radio" required name="limit[type]" id="limitType2" value="0"<?=isset($itemData['otherData']['type']) && $itemData['otherData']['type'] == 0 ? 'checked':''?>>
							      无指定时间段
							      </label>
							    <div id="timeInputBox" class="input-group col-md-4 col-xs-6 col-sm-6" style="margin-top: 5px; width: 400px;">
							       <input type="text" class="form-control" name="limit[startTime]" id="startTime" value="<?=isset($itemData['otherData']['startTime']) ? $itemData['otherData']['startTime'] : ''?>" onFocus="WdatePicker({onpicked:function(){$dp.$('endTime').focus();},maxDate:'#F{$dp.$D(\'endTime\')}'})" placeholder="开始时间">
							       <span class="input-group-addon">至</span>
							       <input type="text" class="form-control" name="limit[endTime]" id="endTime" value="<?=isset($itemData['otherData']['endTime']) ? $itemData['otherData']['endTime'] : ''?>" onFocus="WdatePicker({minDate:'#F{$dp.$D(\'startTime\')}'})" placeholder="结束时间">
							    </div>
							</td>
						</tr>
						<tr align="center">
							<td colspan="2">
								<button type="submit" class="btn btn-default btn-primary">完成编辑</button>
					  			<button type="button" onclick="closeWindow()" class="btn btn-default btn-primary">取消</button>
							</td>
						</tr>
					</tbody>
				</table>
			</form>